The Absence of Burnout Does Not Equal Wellness
Burned out on burnout? Discussions about the crisis of physician burnout are everywhere, from medical journals to mainstream media. The statistics are troubling with over half of all physicians reporting at least one symptom of burnout. Physicians are leaving medicine early, and the number who would recommend medicine as a career continues to decline. Experts cite both organizational and individual approaches to mitigate burnout including flexible work schedules, the use of scribes, electronic medical record improvements, and mindfulness classes. These are steps in the right direction.
The larger truth in this crisis is the absence of burnout does not equal wellness. Most physicians are able to function. We get through our days, make it to some of our kids activities and even manage to go out to dinner on the weekends. We survive the work week as we look forward to our next vacation. We do this because that is what we have always done. We put our heads down and do the work. We often project ourselves past the next exam or to the next stage of our lives to help us get through the stress. We become masters of delayed gratification. We develop the mindset of “I’ll be happy when…” I get into medical school or match into a good residency spot or make partner or have enough money to retire etc…Along the way, we may have some bright spots – falling in love, having kids, taking great vacations. We may even reward ourselves for our hard work with a new car or nicer house. We deserve it. But deep inside, “something is missing”. We have achieved most, if not all of the goals we have set for ourselves. Yet despite our hard work, many of us remain unfulfilled with our careers and often with our lives. What is it that we need? A better job with more money? A different car? A different title? Better vacations?
We have all struggled with these questions and many more. How do I stop wanting what I don’t have and start wanting what I have? How can I fully enjoy the present while also preparing for a better future? How can I spend quality time with my kids while they are still around? How can I have a career that uses all of my potential? Of all the questions that many of us have asked, the most important one was this – How can I learn to flourish and not just function?
Fortunately, there are answers to be found in an evolving field devoted entirely to the scientific study of flourishing: positive psychology. Unlike traditional psychology which alleviates distress and moves a patient from a -8 to a 0 or +1 (if they are lucky), positive psychology focuses on a patient that is functioning at a +1 and tries to move them to a +8 on the flourishing scale. We need both areas of focus. There are many people that are functioning well by most standards but are nowhere near their potential level of fulfilment. Positive psychology can help. It provides a functional blueprint of evidence-based techniques and principles that can guide physicians away from burnout, beyond functioning, and toward flourishing.
While there has been considerable research and advances in Positive Psychology since the field’s inception in 1998, the notion of human flourishing is still mostly absent from mainstream medical practice. Similar to the “medical model” which emphasizes disease treatment and prevention, most solutions to improve physician well-being focus on reducing distress and alleviating burnout. By applying positive psychology principles to the practice of medicine, Positive Medicine offers us a new paradigm that teaches us how to live with more meaning, joy, and fulfillment and ultimately to flourish not just function.
As physicians, we are often too busy to worry about our own happiness. Many people depend on us. We are used to dealing with stress. But the healthcare system will only be as healthy as we are. We owe it to our patients, families and most of all ourselves to prioritize our own well-being. Positive Medicine can help. Over the next several newsletters, we will present some core principles and exercises in Positive Medicine that you can try at home.
Now on to this week’s ideas…but first a brief note – given the feedback from our readers, please see our new physician spotlight section at the end of this newsletter. This allows us to highlight the work of physicians and medical students making a difference in the world. This week, we are featuring David Fessell, MD who is an executive coach, professor of radiology and prior director of the leadership curriculum at the University of Michigan Medical School.
“Focusing on what’s in your zone of control can help – the patient in front you, the key decisions you need to make today. By narrowing the scope of your attention and focus, you can replace seemingly unsolvable issues with doable items. You’ll feel relief and satisfaction as you accomplish them.”
Drawing on their combined 29 years of research in the world of emotional intelligence, best-selling author Daniel Goleman and executive coach David Fessell discuss why it’s critical for healthcare professionals to pay attention to their emotional lives in order to remain effective and healthy themselves – especially in times of crisis.
2. How Marcus Aurelius Conquered Stress (and the Rest of Us Can Too)
“Stress is an inevitable part of life. It is the friction of the plates of our responsibility rubbing against each other. But if stress is inevitable, anxiety and anger and worry are not. Marcus believed that these things were a choice. That we could work past them, through them, that we could discard them, as he said, because they are within us, or at least up to us”
To say that Marcus Aurelius had a stressful life would be an understatement. Running the largest empire in the world while facing coups, plagues, an unfaithful wife and troublesome son, Marcus talks openly about his daily struggles and strategies with anxiety, anger and virtue in his private journal Meditations. In this post, best-selling author Ryan Holiday shows us how we can use these lessons learned over 2000 years ago to improve our own ability to effectively deal with stress and manage our emotions.
3. Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being | NEJM
“We have a brief window of opportunity to get ahead of two pandemics, the spread of the virus today and the harm to clinician well-being tomorrow. If we fail, we will pay the price for years to come. In the race to respond to the Covid-19 crisis, we must not neglect to care for those who care for us.”
In this NEJM article, Drs Dzau, Kirch, and Nasca from the Collaborative on Clinician Well-Being and Resilience discuss 5 high priority organizational and national actions to protect the well-being of our workforce during and after the Covid-19 pandemic.